scholarly journals Lung Ultrasound in the Emergency Department for Early Identification of COVID-19 Pneumonia

Respiration ◽  
2020 ◽  
pp. 1-9
Author(s):  
Alessandro Zanforlin ◽  
Giacomo Strapazzon ◽  
Markus Falk ◽  
Valentina Gallina ◽  
Antonio Viteritti ◽  
...  
Keyword(s):  
Emergency Department ◽  
Roc Curve ◽  
Outpatient Treatment ◽  
Early Identification ◽  
Lung Ultrasound ◽  
Health Care Systems ◽  
Area Under The Curve ◽  
Nasopharyngeal Swab ◽  
Imaging Features ◽  
Care Systems

<b><i>Background:</i></b> Coronavirus disease 2019 (COVID-19) is a pandemic overwhelming the health care systems worldwide. Lung ultrasound (LUS) use has been proposed to identify suspected COVID-19 patients and direct them to the isolation area in the emergency department (ED) or to discharge them for outpatient treatment. <b><i>Objective:</i></b> Our aim was to retrospectively investigate the use of LUS in the ED to identify COVID-19 pneumonia (CP). <b><i>Methods:</i></b> We performed a retrospective single-center study including all patients accessing the ED who underwent LUS examination for suspicion of COVID-19 during the initial outbreak. Demographics, clinical parameters, laboratory values, imaging features, and outcome variables were collected. The receiver operating characteristic (ROC) curve was used to evaluate diagnostic accuracy. <b><i>Results:</i></b> A total of 41% patients were COVID-19-positive; 67% of them were diagnosed with CP. The ROC curve of the LUS score showed an area under the curve of 0.837 (95% CI 0.75–0.92) and with a cutoff value ≥3 identified 28 of 31 patients with CP and 11 of 15 without (sensitivity 90%, 95% CI 74–97%; specificity 75%, 95% CI 56–76%). LUS in combination with nasopharyngeal swab has a sensitivity of 100% (95% CI 74–97%) and a specificity of 61% (95% CI 44–67%). <b><i>Conclusions:</i></b> LUS is a promising technique for early identification of CP in patients who accessed the ED in an active epidemic time. The LUS score shows a sensitivity of 90% for CP, allowing to quickly direct patients with COVID-19 to the ED isolation area or to discharge them for outpatient treatment.

scholarly journals Separating the wheat from the chaff – COVID-19 in a German emergency department: A Case-control study

2020 ◽  
Author(s):  
David Fistera ◽  
Dirk Pabst ◽  
Annalena Härtl ◽  
Benedikt Michael Schaarschmidt ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Systems ◽  
University Hospital ◽  
Nasopharyngeal Swab ◽  
Workflow Model ◽  
Manchester Triage System ◽  
Efficient Management ◽  
Care Systems ◽  
To Come ◽  
The University

Abstract Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the Emergency Department. Especially the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved?Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia.Results: 43 of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.Trial registration: URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021675

scholarly journals Separating the Wheat From the Chaff – Covid-19 in a German Emergency Department: A Case-control Study

2020 ◽  
Author(s):  
David Fistera ◽  
Dirk Pabst ◽  
Annalena Härtl ◽  
Benedikt Michael Schaarschmidt ◽  
Lale Umutlu ◽  
...  
Keyword(s):  
Emergency Department ◽  
Health Care Systems ◽  
University Hospital ◽  
Nasopharyngeal Swab ◽  
Workflow Model ◽  
Manchester Triage System ◽  
Efficient Management ◽  
Care Systems ◽  
To Come ◽  
The University

Abstract Background: COVID-19 pandemia is a major challenge to worldwide health care systems. Whereas the majority of disease presents with mild symptoms that can be treated as outpatients, severely ill COVID-19 patients and patients presenting with similar symptoms cross their ways in the Emergency Department. Especially the variety of symptoms is challenging with primary triage. Are there parameters to distinguish between proven COVID-19 and without before? How can a safe and efficient management of these inpatients be achieved?Methods: We conducted a retrospective analysis of 314 consecutive inpatient patients who presented with possible symptoms of COVID-19 in a German emergency department between March and April 2020 and were tested with a SARS-Cov-2 nasopharyngeal swab. Clinical parameters, Manchester Triage System categories and lab results were compared between patients with positive and negative test results for SARS-Cov-2. Furthermore, we present the existing COVID-19 workflow model of the university hospital in Essen which proved to be efficient during pandemia.Results: 43 of the 314 patients (13.7%) were tested positive for COVID-19 by SARS-Cov-2 nasopharyngeal swab. We did not find any laboratory parameter to distinguish safely between patients with COVID-19 and those with similar symptoms. Dysgeusia was the only clinical symptom that was significantly more frequent among COVID-19 patients. Conclusion: Dysgeusia seems to be a typical symptom for COVID-19, which occurred in 14% of our COVID-19 patients. However, no valid parameters could be found to distinguish clinically between COVID-19 and other diseases with similar symptoms. Therefore, early testing, a strict isolation policy and proper personal protection are crucial to maintain workflow and safety of patients and ED staff for the months to come.Trial registration: URL: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00021675

Hurricane Impact on Emergency Services and Use of Telehealth to Support Prehospital Care

2019 ◽  
Vol 14 (1) ◽  
pp. 39-43
Author(s):  
David M. French ◽  
Greg A. Hall ◽  
Todd McGeorge ◽  
Michael Haschker ◽  
Joseph G. Brazeal ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Management ◽  
Emergency Services ◽  
Health Care Systems ◽  
Prehospital Care ◽  
Storm Duration ◽  
Care Systems ◽  
Hurricane Impact ◽  
State And Local ◽  
The Impact

ABSTRACTThe impact of hurricanes on emergency services is well-known. Recent history demonstrates the need for prehospital and emergency department coordination to serve communities during evacuation, storm duration, and cleanup. The use of telehealth applications may enhance this coordination while lessening the impact on health-care systems. These applications can address triage, stabilization, and diversion and may be provided in collaboration with state and local emergency management operations through various shelters, as well as during other emergency medical responses.

scholarly journals Trends in Emergency Department Visits and Hospital Admissions in Health Care Systems in 5 States in the First Months of the COVID-19 Pandemic in the US

2020 ◽  
Vol 180 (10) ◽  
pp. 1328 ◽  
Author(s):  
Molly M. Jeffery ◽  
Gail D’Onofrio ◽  
Hyung Paek ◽  
Timothy F. Platts-Mills ◽  
William E. Soares ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Hospital Admissions ◽  
Health Care Systems ◽  
Emergency Department Visits ◽  
The Us ◽  
Care Systems

scholarly journals Retrospective validation of a new volumetric capnography parameter for the exclusion of pulmonary embolism at the emergency department

2018 ◽  
Vol 4 (4) ◽  
pp. 00099-2018
Author(s):  
Timon M. Fabius ◽  
Michiel M.M. Eijsvogel ◽  
Marjolein G.J. Brusse-Keizer ◽  
Olivier M. Sanchez ◽  
Franck Verschuren ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Diagnostic Accuracy ◽  
Roc Curve ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Carbon Dioxide Production ◽  
Pulmonary Angiography ◽  
Volumetric Capnography

Volumetric capnography might be used to exclude pulmonary embolism (PE) without the need for computed tomography pulmonary angiography. In a pilot study, a new parameter (CapNoPE) combining the amount of carbon dioxide exhaled per breath (carbon dioxide production (VCO2)), the slope of phase 3 of the volumetric capnogram (slope 3) and respiratory rate (RR) showed promising diagnostic accuracy (where CapNoPE=(VCO2×slope 3)/RR).To retrospectively validate CapNoPE for the exclusion of PE, the volumetric capnograms of 205 subjects (68 with PE) were analysed, based on a large multicentre dataset of volumetric capnograms from subjects with suspected PE at the emergency department. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve and diagnostic accuracy of the in-pilot established threshold (1.90 Pa·min) were calculated. CapNoPE was 1.56±0.97 Pa·min in subjects with PE versus 2.51±1.67 Pa·min in those without PE (p<0.001). The AUC of the ROC curve was 0.714 (95% CI 0.64–0.79). For the cut-off of ≥1.90 Pa·min, sensitivity was 64.7%, specificity was 59.9%, the negative predictive value was 77.4% and the positive predictive value was 44.4%.The CapNoPE parameter is decreased in patients with PE but its diagnostic accuracy seems too low to use in clinical practice.

Emergency Medicine Pharmacy Practice

2011 ◽  
Vol 24 (2) ◽  
pp. 135-145 ◽  
Author(s):  
Maria I. Rudis ◽  
Ryan J. Attwood
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Medicine ◽  
Clinical Pharmacist ◽  
Health Care Systems ◽  
Pharmacy Practice ◽  
Health Care Team ◽  
The Past ◽  
Care Systems

Emergency medicine (EM) pharmacy practice has existed for over 30 years. In recent years, however, the specialty has grown significantly. A large number of health care systems have either a dedicated EM pharmacist or other clinical pharmacist presence in the Emergency department (ED). Over the past decade, the role of the EM pharmacist as a critical member of the health care team has expanded significantly and many innovative practices have evolved throughout the country. There is also some heterogeneity between different EM pharmacy practice sites. This article reviews the history and general concepts of EM pharmacy practice as well as illustrate some of the established benefits of an EM pharmacist.

Effects of an antipsychotic restriction policy in a veteran population

2013 ◽  
Vol 3 (1) ◽  
pp. 13-19 ◽  
Author(s):  
Nicole Cupples ◽  
Cynthia A. Mascarenas ◽  
Troy A. Moore
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Emergency Department ◽  
Index Date ◽  
Hemoglobin A1c ◽  
Health Care Systems ◽  
Psychotropic Medications ◽  
Emergency Department Visits ◽  
Care Systems ◽  
Secondary Outcomes

Introduction: Recent trials have failed to demonstrate differences in efficacy between first generation antipsychotics (FGAs) and second generation antipsychotics (SGAs). To reduce costs, many health care systems have restricted the availability of SGAs through use of prior authorizations. Restrictions for the off-label use of SGAs and the use of dual-antipsychotic therapy have also been implemented in many health care systems. At the South Texas Veterans Health Care System (STVHCS), a restricted drug request (RDR) method has been implemented to manage costs and improve patient safety. Risperidone, due to its lower cost and equal efficacy, is the first-line option of SGAs. If one wishes to prescribe an SGA other than risperidone, an RDR is submitted and reviewed by Veterans Integrated Service Network (VISN) pharmacists. Since the introduction of these policies at the STVHCS, the impact of the RDR has not been assessed. Rationale: The primary aim of this study was to determine the effects of the RDR policy on the care of STVHCS veterans as evidenced by changes in hospitalization rates of veterans with a denied request for an SGA due to initial criterion failure. Secondary outcomes included: impact of antipsychotic RDR denial on mental health as evidenced by changes in no-shows and cancellations for follow-up psychiatric appointments, psychiatric emergency department visits, presence of suicidal ideation, change in weight, hemoglobin A1c, number of psychotropic medications prescribed, and extrapyramidal symptoms. Methods: A retrospective chart review of veterans denied an initial SGA request was conducted from 3 months prior to denial to 3 months post request denial (index date). Data collected included: patient demographics, indication for SGA request, reason for SGA denial, length of time for request evaluation, number of psychiatric hospitalizations, number of no-shows and cancellations for mental health appointments, number of psychiatric emergency department visits, number of reports of suicidal ideation or attempts, weight, hemoglobin A1c lab results, presence of extrapyramidal symptoms, and number of prescribed psychotropic medications. The health care utilization data collected pre- and post-index date, were compared. Results were analyzed using Fisher's Exact, 2-tailed standardized t-tests, and descriptive statistics appropriately matched to data type. Results: Results for both primary and secondary outcomes were not statistically significant. No differences were found in the number of veterans hospitalized pre- versus post-index date [0/33 (0%) versus 2/33 (6%), p=0.492.] The most requested indication for an SGA was PTSD [22/33 (66.7%)] and the most frequently denied SGA was quetiapine [16/33 (48.5%)]. Conclusions: Although outcomes were not statistically significant, several valuable conclusions were drawn from this research. Positive outcomes from a RDR policy were seen by the limitations placed on inappropriate medication prescribing. Also, it was observed that the number of approvals for SGAs was almost three times higher than denials. A subsequent finding from this research is the apparent lack of metabolic monitoring for veterans prescribed SGAs. Further research on these observations, as well as conducting a pharmacoeconomic analysis on the RDR policy, would also be beneficial information for health care providers.

scholarly journals Seeking Care for Hyperglycemia in the Emergency Department: Through the Eyes of the Patient

2020 ◽  
Author(s):  
Justin W. Yan ◽  
Dimah Azzam ◽  
Melanie P. Columbus ◽  
Kristine Van Aarsen ◽  
Selina L. Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Care Providers ◽  
Health Care Settings ◽  
Care Systems

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

scholarly journals Waiting Times for Outpatient Treatment in Germany: New Experimental Evidence from Primary Data

2018 ◽  
Vol 238 (5) ◽  
pp. 375-394 ◽  
Author(s):  
Nils Heinrich ◽  
Ansgar Wübker ◽  
Christiane Wuckel
Keyword(s):  
Health Insurance ◽  
Outpatient Treatment ◽  
Health Care Systems ◽  
Waiting Times ◽  
Time Frame ◽  
Public Health Care ◽  
Primary Data ◽  
P Value ◽  
Before And After ◽  
Care Systems

Abstract Long waiting times are a common feature and a major concern in many public health care systems. They are often characterized as inefficient because they are a burden to patients without generating any gains for providers. There is an ongoing debate in Germany regarding the preferential treatment given to private health insurance (PHI) holders while statutory health insurance (SHI) holders face continuously increasing waiting times. In order to tackle this problem in the outpatient sector, Germany initiated a reform in 2015 which was aimed at providing SHI holders with appointments within an acceptable time frame. We exploit longitudinal experimental data to examine waiting times for six elective outpatient treatments in Germany for PHI and SHI holders before and after the reform. We find a considerable difference in waiting times favoring private patients. For SHI holders, waiting times remained stable over time (27.5 days in 2014, 30.7 days in 2016, Δ 3.2 days, p-value=0.889) while PHI holders experienced a significant improvement (13.5 days in 2014; 7.8 days in 2016; Δ 5.7 days, p-value=0.002). The results indicate that even after the reform there is still an unequal access to elective outpatient treatment depending on the patient’s insurance status.

Sign in / Sign up

Export Citation Format

Share Document